BRAIN GAMES

Choose the true statement about lower abdominal

obesity
a) Also called, Apple shaped obesity
b) Waist to hip ratio (< 1 for men and <0.8 for women)
c) Relatively common in females
d) Also called, Pear shaped obesity
e) Waist to hip ratio (>0.8 for women and >1 for men)

f) Relatively common in males

g) B, C and D are correct
h) A, E and F are correct

BRAIN GAMES
How many minutes of physical activity
recommended each day for weight loss?
a) 60 minutes
b) 45 minutes
c) 30 minutes
d) 70 minutes
e) 15 minutes

are

BRAIN GAMES
Rank the saturated fat content of these fast foods
from highest to lowest: a) Nandos double chicken
breast burger b) Pret A Manger mature cheddar and
pickle sandwich c) McDonald's Big Mac d) Burger
King Whopper.
a)B, D, C, A
b)C, D, B, A
c)C, B, D, A
d)D, C, A, B

BRAIN GAMES
Dieting is the most commonly practiced approach to
weight control. One can estimate the effect of calorie
restriction on the reduction in adipose tissue. Since 1
pound of adipose tissue corresponds to kcal.
a) 1500
b) 3000
c) 3500
d) 2000
e) 2500
f) 1000

BRAIN GAMES
Bariatric surgery is an increasingly prevalent treatment
option for patients with obesity. Choose the incorrect
statement about it:
a) Most popular is the rouxenY gastric bypass
b) The operation can be done laparoscopically
c) Can be the treatment of choice for any grade of obesity
d) results in substantial amounts of weight lossclose to
50% of initial body weight
e) Can lead to long-term vitamin/mineral deficiencies
particularly deficits in vitamin B12, iron, calcium, and folate

BRAIN GAMES
Orlistat is the only FDA approved drug for
treatment of obesity, the mechanism of action
involves:
a) Increasing BMR
b) Inhibition of appetite center
c) Promotes satiety
d) Inhibition of gastric and pancreatic lipases
e) A and D are correct
f) B and C are correct

OBESITY
Edalyn R. Capili
Metropolitan Medical Center
College of Medicine

BODY MASS INDEX

BMI is a person's weight in kilograms divided by the
square of height in meters.
A high BMI can be an indicator of high body fatness.
used to screen for weight categories that may lead to
health problems but it is not diagnostic of the body
fatness or health of an individual.
At the same BMI:
women have more body fat than men.
Blacks have less body fat than do Whites, and Asians have more body
fat than do Whites
older people have more body fat than younger adults.
athletes have less body fat than do non-athletes

BODY MASS INDEX

Classification

BMI (kg/m)

Underweight

<18.50

Severe thinness

<16.00

Moderate thinness

16.00-16.99

Mild thinness

17.00-18.49

NORMAL RANGE

18.50-24.99

Overweight

25.00

Pre-obese

25.00-29.99

Obese Class I

30.00-34.99

Obese Class II

35.00-39.99

Obese Class III

40.00

ANATOMIC DIFFERENCES IN
FAT DEPOSITION
Waist-to-hip ratio of >0.8 (women) and >1.0 (men) android,
apple-shaped or upper body obesity
Waist-to-hip ratio of <0.8 (women) and <1.0 (men) gynoid,
pear-shaped or lower body obesity
80-90% of body fat stored is in subcutaneous depots
10-20% of body fat stored is in visceral depots

BIOCHEMICAL DIFFERENCES IN
REGIONAL FAT DEPOTS
ENDOCRINE FUNCTION
Adipocyte cell that secretes protein regulators such
as:
LEPTIN regulates appetite and metabolism
ADIPONECTIN reduces levels of FFAs in
blood, associated with improved lipid profiles,
increased insulin sensitivity (better glycemic control)
and reduced inflammation in diabetic patients
*As body weight increases, adiponectin levels
decrease and leptin levels increase.

BIOCHEMICAL DIFFERENCES IN
REGIONAL FAT DEPOTS
IMPORTANCE OF PORTAL CIRCULATION
Obesity increases the release of FFAs and secretion
of proinflammatory cytokines (IL-6) from adipose
tissue.
FFAs and cytokines released from these depots
enter portal vein and have direct access to the liver.
They may lead to insulin resistance and hepatic
synthesis of TAGs (released as components of VeryLow-Density Lipoprotein particles), contribute to
hypertriacylglycerolemia associated with obesity.

SIZE and NUMBER of FAT CELLS

As TAGs are stored,
adipocytes expand 2-3X
their normal value.
However, fat cells ability to
expand is limited. With
prolonged
overnutrition,
preadipocytes
are
stimulated to proliferate
and
differentiate
into
mature fat cells, increasing
number of adipocytes.

EPIDEMIOLOGY
The average height of adult Filipinos 20 yrs and
older is 163 cm (M) and 151.4 cm (F), while the
average weight for males is 61.3 kg and for
females is 54.3 kg.
3 out of 10 Filipino adults 20 years old and above
are either overweight or obese.
According to the FNRI, the prevalence of obesity
may be attributed to high and fast living where
lifestyle is sedentary, fast foods are abundant,
and planning and preparation of nutritious food
for the family is not of prime importance.

RISK FACTORS
All-causes of death (mortality)
High blood pressure (Hypertension)
High LDL, low HDL, or high levels of
triglycerides (Dyslipidemia)
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis
Sleep apnea and breathing problems
Some cancers (endometrial, breast, colon,
kidney, gallbladder, and liver)
Low quality of life
Mental illness (clinical depression, and anxiety)
Body pain and difficulty with physical functioning

BODY WEIGHT REGULATION

Each
individual
has
a
biologically
predetermined set point for body weight.
The body attempts to add adipose tissue
when BW falls below the set point, and to
lose weight when BW is higher than the set
point.
GENETIC CONTRIBUTIONS TO OBESITY
Children who are adapted usually show a
BW that correlates with their biologic rather
than adoptive parents.
Identical twins have very similar BMIs.
Mutations in the gene for leptin or its receptor
produce HYPERPHAGIA (increased appetite
and consumption of food).
Most obese have elevated leptin levels but
appear to be resistant to this hormone.

BODY WEIGHT REGULATION

ENVIRONMENTAL AND
BEHAVIORAL CONTRIBUTIONS
ready availability of palatable,
energy-dense foods
sedentary lifestyles encouraged
by TV watching, autos, computer
usage, and energy sparing devices
in the workplace and at home
decrease physical activity
eating
behaviors
(snacking,
portion size, variety of foods
consumed,
unique
food
preferences and no. of people
present during eating)

PATHOLOGY

MOLECULES THAT
INFLUENCE OBESITY
Long term signals
LEPTIN
-adipocyte peptide hormone secreted in
proportion to the size of fat stores
-when we consume fewer calories than we
need, body fat declines and leptin
production decrease
-body adapts by minimizing energy
utilization and increasing appetite
-effects mediated through binding to its
receptors in the arcuate nucleus of
hypothalamus

MOLECULES THAT INFLUENCE

OBESITY
Short term signals
In the absence of intake (between meals),
the stomach produces GHRELIN.
As food is consumed, gut hormones (CCK
and peptide YY), induce satiety.
Within the hypothalamus:
Neuropeptides - neuropeptide Y, -MSH
Neurotransmitters serotonin, dopamine

METABOLIC CHANGES IN OBESITY

METABOLIC SYNDROME
glucose intolerance
(hyperglycemia), insulin
resistance,
hyperinsulinemia,
dyslipidemia (low HDL and
elevated TAGs), and
hypertension
associated with low-grade,
chronic, systemic
inflammation
adipocytes release
proinflammatory mediators
(IL-6)
low levels of adiponectin

MANAGEMENT
WEIGHT REDUCTION
Help reduce complications of obesity (T2D and
hypertension)
Physical activity
Increases cardiopulmonary fitness and reduces risk of
cardiovascular disease, independent of weight loss
Caloric restriction and exercise with behavioral treatment
lose 5-10% of initial BW over 4-6 months
Caloric restriction
1 pound of adipose tissue corresponds to 3,500 kcal
Weight losses of 10% BW over 6 months period reduce
BP and lipid levels and enhance control of T2D

MANAGEMENT
Pharmacologic treatment
Orlistat- decreases absorption
of dietary fat
Lorcaserin- promotes satiety
Combination:
Phentermine- suppresses
appetite
Topiramate- controls seizures
Surgical treatment
Gastric bypass and restriction
surgeries- improve poor blood
sugar control in morbidly
obese diabetic individuals

CONCEPT MAP FOR OBESITY

THANK YOU FOR

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